Barotrauma of the ear is injury from a pressure difference across the eardrum when the eustachian tube cannot equalize, most often while flying or diving. It ranges from mild ear pain to a ruptured eardrum or, rarely, inner ear damage.
Key symptoms
- Ear pain or fullness during descent in a plane or dive
- Muffled hearing
- Ringing in the ear (tinnitus)
- Vertigo, nausea or sudden hearing loss if the inner ear is affected
What you find on exam
- Otoscopy: pulled-in, red eardrum, with blood or fluid behind it
- Eardrum perforation in severe cases
- Tuning fork tests to separate conductive from sensorineural loss
- Nystagmus and balance testing
Tests
- Diagnosis is usually clinical
- Audiogram if hearing loss persists or is sensorineural
- Tympanometry for middle ear function
- Urgent ENT review if inner ear barotrauma is suspected
Treatment basics
- Pain relief such as ibuprofen
- Short course of decongestant: oxymetazoline nasal spray or pseudoephedrine
- Gentle pressure equalizing only; no diving or flying until healed
- Keep the ear dry if perforated; most heal within weeks
- Inner ear injury: rest with head raised, urgent ENT, surgery for a fistula
Red flags
- Sudden hearing loss, severe vertigo or tinnitus after a dive
- Neurological symptoms after diving (think decompression sickness)
- Discharge and fever after a perforation
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.